Healthcare Provider Details

I. General information

NPI: 1962476697
Provider Name (Legal Business Name): VISHWAJIT NIMGAONKAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 05/24/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 OHARA ST ROOM 441
PITTSBURGH PA
15213-2561
US

IV. Provider business mailing address

3811 OHARA ST ROOM 441
PITTSBURGH PA
15213-2561
US

V. Phone/Fax

Practice location:
  • Phone: 412-246-6353
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberMD041976L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: